Outcome Results on Ablation versus Surgery for HCC: A Report from the SEER Registry
Percutaneous ablation is maturing as an important part of the treatment armamentarium for HCC. The relative efficacy of ablation techniques compared to surgery remains controversial and current guidelines from the Barcelona Clinic Liver Cancer (BCLC) recommend ablation only for patients who are not surgical candidates. These recommendations are derived from a very limited evidence base, with only one prospective study demonstrating superior outcomes after surgery. The SEER registry offers a powerful resource to answer these questions, affording a large patient sample from diverse medical institutions and detailed survival outcome data. The authors of this paper effectively identified potential confounders including patients who had received both treatments or went on to receive a liver transplant. The results of their study demonstrate equivalent survival outcomes in tumors <4 cm, which suggests that it would be reasonable to consider ablation as an alternative to surgery in this patient population. The results in the 4-5 cm tumor group demonstrated superiority of surgery, reflecting limitations of ablation in larger tumor sizes. The SEER population included both patients who had been treated with radiofrequency and microwave ablation (and does not differentiate the two modalities), so it could not be determined in this study whether outcomes in these larger tumors may be superior with microwave. It is important to recognize limitations to the SEER data including lack of BCLC or Child-Pugh scores, performance status, or comorbidities, which may all be important contributors to survival. Nonetheless, this study serves as additional evidence that percutaneous ablation affords equivalent survival outcomes to surgery in HCC ≤4 cm and may help to further define the evolving role of ablation in the treatment of HCC patients.
Click here for abstract
Mironov O, Jaberi A, Kachura JR. Thermal Ablation versus Surgical Resection for the Treatment of Stage T1 Hepatocellular Carcinoma in the Surveillance, Epidemiology, and End Results Database Population. J Vasc Interv Radiol 2017; 28:325-33.
Jeffrey Forris Beecham Chick, MD, MPH, DABR
Assistant Professor of Vascular and Interventional Radiology
Vice Quality Assurance and Safety Officer
Venous Health Program Faculty
University of Michigan Health System
James X. Chen, MD
Resident in Radiology
Hospital of the University of Pennsylvania